Mental health in the workplace: The struggles employers face – and what can be done

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By all accounts, Dennis Miller, CEO of his company, has had a successful career. He's served in executive positions across several non-profit organizations and is now a published author and speaker. He's also been enabled to do his work thanks to therapy for mental illness.

But it's only in recent decades that he has been able to openly address his experience, or even say that he first sought therapy when he was 20 years old.

"I talk about this deep secret I kept because I was so ashamed of it," he said. "I was a president of a major medical center but I still felt stigma."

As companies are pressed to push down healthcare costs, wellness programs have resurged as a way to encourage employee health, reduce claims and improve a company's recruitment brand. The market has responded in turn — meaning mental health may finally be emerging from the shadows.

"I was a president of a major medical center but I still felt stigma."

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"We're seeing this as a tipping point right now," Meena Ramachandran, senior director of product management at Castlight, told HR Dive. "For the first time we are seeing huge demand for this type of support for employees and seeing support in ways that weren't talked about before."

Employers still face considerable challenges, particularly the specter of stigma and problems tracking utilization. But benefits platforms like Castlight and YourNurse are emerging to guide employers toward a more holistic wellness — and create a better atmosphere for employees in all walks of life.

"We are at a point in our culture and history that we can open up about emotional stuff, and it is not soft stuff," Miller said. "It's business."

Breaking through stigma

Blood pressure, diabetes and cholesterol screenings are all considered the norm. So are smoking cessation programs — set to cease a habit that was at one time considered normal. Openness about physical health, including cancer and diabetes, has improved over decades. But for many, mental wellness remains a topic fraught with shame and stigma.

"The business just kind of sees it as a labor issue only without realizing that the whole organization will do better when people are healthier," Miller said.

Ramachandran said her company spent close to a year speaking with users and combing the literature to distill the stigma issue down to four facets that employers can help tackle.

For employers, the first step is to encourage openness and instill awareness. Many employees do not realize they are struggling or experiencing symptoms of a mental illness. Finding ways to subtly encourage them to seek help, either through education programs or access to personalized healthcare platforms, is key.

Others are concerned that care won't actually be effective for their problems, Ramachandran said, tying directly into stigma and a belief that there isn’t an illness at fault but rather a personal flaw.

Cost (or the perception of cost) can be a barrier. Some do not realize that there is high-value care for mental health.

Perception of access can also be an issue.

YourNurse, a call service that guides employees through health benefits, tackles awareness through its one-point call system. Nurses respond to calls from employees and guide them toward the care that they need, rather than having an employee figure out on their own which service to call. Jamie Marcellus, RN, President of First Health Care, noted that nursing is a "trusted profession." Employees feel more willing to open up to someone they believe is truly listening to them.

Often, the reason for calling is the "tip of the iceberg," he added. The nurses can then arrange for the employee to receive the care they need for all facets of their health.

"As stigma starts to erode and as people become more aware of mental health challenges among the broader population, more employers are figuring out how to support employees during a time of need," Marcellus said.

Many employers already have Employee Assistant Programs and other support programs in place for this purpose. But due to the fragmented nature of these programs — a different program for every need, be it physical, mental or financial health — employers are consistently concerned about the actual value they are receiving.

Breaking out of silos

Despite an increased interest in holistic wellness from employers, the health and wellness industry still tends to operate in silos, Marcellus said. Typically, organizations will sign with an EAP for mental health, a health assessment service for physical health, and so on. Inevitably, employers have challenges in maximizing use of these services while also addressing the complex, multifaceted issues employees face.

In response, the industry is shifting. Both YourNurse and Castlight provide a single touchpoint that employees can use to overview their benefits, easing confusion and encouraging engagement. YourNurse provides a single number that employees can call when they require assistance, while Castlight’s platform gives employees an overview of providers they can compare on cost and quality.

Breaking down reporting

But the current siloed state of wellness has led to another issue in the industry, particularly with mental health initiatives: reporting results and the end value of such services.

“Organizations will have five to six services they purchased and they have no idea of knowing what that’s worth,” Marcellus said. “It’s difficult for organizations to really understand what employees are using, how, and if they are seeing value for that use.”

Additionally, employees often have their own apps and devices they use to track their wellness that do not get reported to an employer, Ramachandran said. An aggregator has yet to emerge that safely tracks such wellness forms.

Castlight Health's platform at work.

Castlight Health

Current utilization calculations don’t help, either. Many providers capture every interaction with an employee and charge that back as utilization, regardless of whether value was gained from it by the employee.

“We force organizations to take a pause to look at who is accessing services,” Marcellus said. In some cases, there may be a difference between actual utilization and what is recorded – a particular problem if actual utilization is higher than expected. If one in four employees are accessing services, for example, there may be a bigger workplace problem that needs to be addressed, he added.

In all, organizations should take care to better observe their utilization and find ways to optimize tracking of value added.

Breaking down the law

Employers instituting mental wellness into their plans should be aware of new laws that are entering Congress for consideration — and that have a high chance of eventually passing muster thanks to bi-partisan support.

Between a law from 2008, the Mental Health Parity and Addiction Equity Act, and requirements from the Affordable Care Act, employers have had to pay particular attention to what is required in a health plan concerning mental health, said Allison Klausner, government relations leader at Xerox HR Services.

The original 2008 act says that a plan is not required to provide mental health coverage, but if it does, it must be "on the same level playing field" as physical coverage, Klausner said. Now, the legislature is trying to clarify just what is required by this rule.

The bills currently under consideration describe what it would mean to be compliant and how a company would be checked for compliance. Essentially, companies would be subject to an audit.

"Now, employers may want to seek out a self-audit check and go through a way a plan is written and operated," Klausner said. "How are you operating? What are you actually doing when someone says 'I need to have a residential stay' due to addiction, depression, or another mental health issue?"

There are currently four active bills out there based on mental health parity with significant bi-partisan and bi-cameral support.

"We should anticipate that even if not enacted in current Congress, we would likely see that the blueprint of legislation introduced would be very similar," Klausner said.

What employers can do now

As holistic wellness garners attention, mental health initiatives will continue — because, in many cases, employers are already "paying for it" in lost productivity, Miller said. Such initiatives can scale appropriately.

Castlight made headlines recently due to its ability to track employees' behavior on their platform and to push information when it senses an employee searching about a relevant topic. Technology will likely continue to play a large role in making wellness more rounded overall.

"Understand that you can be a good employer and a good business person, too."

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"The technology will evolve around those painpoints that are being talked about by employers and employees," Ramachandran said. That includes combinations of telemedicine and behavioral health, as well as computerized cognitive therapy and other tech-enabled solutions.

"I would utilize the free expertise that you can get from associations, the county government and behavioral health organizations," Miller added. "Invite them in to talk to you. Start a campaign."

Frontline HR managers should be educated on how to recognize a potential mental health problem and how to approach someone about that problem.

"Understand that you can be a good employer and a good business person, too," Miller added. "The good news is that you can get treatment. I did. You have to envision the kind of life you want to have and treat people the way you want to be treated."